Job Description
📋 Description Conduct pre-, post-payment and auto-adjudication audits for routine to moderate claims Verify processing, payment and financial accuracy per SPDs, regs and SOPs Meticulously track and report audit results for reporting and trends Identify corrections and verify adjustments are complete and accurate Identify trends from quality reviews and drive root-cause improvements Investigate claim issues to improve standard processing guidelines 🎯 Requirements Bachelor’s Degree or equivalent work experience 2 years auditing medical claims for a health insurer or TPA Extensive (5 years) medical claims processing background Ability to analyze data and identify trends; apply 5 Whys for root cause Core system configuration knowledge Ability to articulate findings and defend methodology 🎁 Benefits Alternative medicine coverage Flexible PTO Up to 16 weeks paid parental leave Paid holidays 401k program Transportation perks
